Liver-directed Therapy
Liver-directed therapy is a form of cancer treatment in which the vessels bringing blood to the liver are accessed by an interventional radiologist using an X-Ray guidance. This is done in a manner similar to how stents are placed in the heart for heart attack. This approach may be used for two purposes.
One purpose is to deliver chemotherapy into the liver artery in a very high dose to the specific part of the liver where the tumor is and also to block the particular vessel branches feeding the tumor. Thus, the cancer is being attacked simultaneously by “blasting” it with very high doses of chemotherapy and at the same time by cutting off its blood supply. This is called chemoembolization. Embolization is an act of blocking off the blood supply. A variant of this approach is radioembolization. In this case, instead of delivering high dose of chemotherapy, microscopic glass beads loaded with radiation are injected in the vessels feeding the cancer. These small radioactive beads are lodged into the tiniest capillaries inside the tumor and emit constantly radiation, which is too small of a dose to cause a problem for the patient but is a very high dose for the tumor itself. Thus, overtime the tumor is partially or completely killed by this targeted radiation. When that happens, depending on other factors, surgery may be done to remove the tumor.
Another purpose is to selectively decrease the blood supply to the part of the liver, which contains the cancer, while the other side grows in compensation. Thus, when the other side has grown to an adequate extent, radical surgery can be performed to remove the part of the liver, which contains the cancer. That may be necessary when the part of the liver containing the cancer is too big and removing it without growing the remaining part of the liver may be too dangerous of developing liver failure after surgery due to the remnant of the liver being too small. In that case, the vessel to be accessed is not the artery but the portal vein. The portal vein is the big vein that brings blood from the intestines to the liver, which is a unique feature of the liver anatomy as no other organ has such venous blood supply. This is called portal vein embolization. Dr. Donchev will assess the size of the liver to be removed in respect to the part of the liver to be left in place and will determine if portal vein embolization is necessary.